Provider Demographics
NPI:1295197887
Name:MORIOKA, KATIE C (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:MORIOKA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YELLOWHAWK TRIBAL HEALTH CENTER
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:541-278-4584
Practice Address - Street 1:YELLOWHAWK TRIBAL HEALTH CENTER
Practice Address - Street 2:46314 TIMINE WAY
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-278-4597
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201601590NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200705269Medicaid